Risk factors for local recurrence of superficial esophageal cancer after treatment by endoscopic mucosal resection

Background and study aim: The aim of this study was to elucidate the risk factors for local recurrence after endoscopic mucosal resection (EMR) treatment for superficial esophageal cancer (SEC). Patients and methods: We performed a retrospective analysis of the clinical course of 62 patients with 64 SECs that were treated by EMR between 1993 and 2004. Follow-up examinations by chromoscopy with iodine solution and biopsy were performed 3 months, 6 months, 12 months, and then annually after EMR. Local recurrence was defined as a histologically confirmed finding of cancer cells at the site of the preceding EMR. The contributions of lesion-related and procedure-related factors to local recurrence were analyzed retrospectively. Results: Local recurrence was detected in 14/64 SECs 3 - 36 months after EMR. Of the lesion-related factors we assessed, local recurrence was found to be more frequent in SECs with a larger diameter (P =0.01), larger circumferential spread (P = 0.04), or deeper invasion (P = 0.04), although the last two factors failed to demonstrate statistical significance after correction for multiple testing. Piecemeal resection did not increase the risk of local recurrence (P = 0.11), but the need for adjunctive coagulation therapy was found to increase the risk of local recurrence (P = 0.06). Conclusions: Larger SECs are associated with a higher risk of local recurrence after EMR. In patients with residual lesions, coagulation therapy does not seem to be adequate as additional endoscopic treatment.

References

• 1 Inoue H, Tani M, Nagai K. et al . Treatment of esophageal and gastric tumors.  Endoscopy. 1999;  31 47-55
• 2 Soetikno R, Kaltenbach T, Yeh R. et al . Endoscopic mucosal resection for early cancers of the upper gastrointestinal tract.  J Clin Oncol. 2005;  23 4490-4498
• 3 Ahmad N A, Kochman M L, Long W B. et al . Efficacy, safety, and clinical outcomes of endoscopic mucosal resection: a study of 101 cases.  Gastrointest Endosc. 2002;  55 390-396
• 4 Kodama M, Kakegawa T. Treatment of superficial cancer of the esophagus: a summary of the responses to a questionnaire on superficial cancer of the esophagus in Japan.  Surgery. 1998;  123 432-439
• 5 Shimizu Y, Tsukagoshi H, Fujita M. et al . Long-term outcome after endoscopic mucosal resection in patients with esophageal squamous cell carcinoma invading the muscularis mucosae or deeper.  Gastrointest Endosc. 2002;  56 387-390
• 6 Rösch T, Sarbia M, Schumacher B. et al . Attempted endoscopic en bloc resection of mucosal and submucosal tumors using insulated-tip knives: a pilot series.  Endoscopy. 2004;  36 788-801
• 7 Lambert R. Treatment of esophageal tumors.  Endoscopy. 2003;  35 118-126
• 8 Makuuchi H, Shimada H, Mizutani K. et al . Analysis of long term follow up patients after endoscopic mucosal resection for early esophageal cancer: with special reference to metachronous multiple cancers [in Japanese, English abstract].  Stomach Intest. 1996;  31 1223-1233
• 9 Oyama T, Miyata Y, Okaniwa S. et al . Local recurrence of esophageal squamous cell carcinoma after endoscopic esophageal mucosal resection [in Japanese, English abstract].  Stomach Intest. 1996;  31 1217-1222
• 10 Nomura T, Boku N, Ohtsu A. et al . Recurrence after endoscopic mucosal resection for superficial esophageal cancer.  Endoscopy. 2000;  32 277-280
• 11 Katada C, Muto M, Manabe T. et al . Local recurrence of squamous-cell carcinoma of the esophagus after EMR.  Gastrointest Endosc. 2005;  61 219-225
• 12 Fujishiro M, Yahagi N, Kashimura K. et al . Comparison of various submucosal injection solutions for maintaining mucosal elevation during endoscopic mucosal resection.  Endoscopy. 2004;  36 579-583
• 13 Soetikno R M, Gotoda T, Nakanishi Y. et al . Endoscopic mucosal resection.  Gastrointest Endosc. 2003;  57 567-579
• 14 Yoshida M, Momma K. Endoscopic evaluation of the depth of invasion in cases of superficial esophageal cancer in determining indications for endoscopic mucosal resection [in Japanese].  Nippon Geka Gakkai Zasshi. 2002;  103 337-342
• 15 Rajan E, Gostout C, Feitoza A. et al . Widespread endoscopic mucosal resection of the esophagus with strategies for stricture prevention: a pilot study.  Endoscopy. 2005;  37 1111-1115
• 16 Tada M, Murakami A, Karita M. et al . Endoscopic resection of early gastric cancer.  Endoscopy. 1993;  25 445-450
• 17 Makuuchi H. Endoscopic mucosal resection for early esophageal cancer.  Dig Endosc. 1996;  8 175-179
• 18 Inoue H, Takeshita K, Hori H. et al . Endoscopic mucosal resection with a cap-fitted panendoscope for esophagus, stomach, and colon mucosal lesions.  Gastrointest Endosc. 1993;  39 58-62
• 19 Japanese Society of Esophageal Diseases .Guidelines for the clinical and pathologic studies on carcinoma of the esophagus [in Japanese], 9th edn. Tokyo; Kanehara 1999
• 20 Araki K, Ohno S, Egashira A. et al . Pathologic features of superficial esophageal squamous cell carcinoma with lymph node and distant metastasis.  Cancer. 2002;  94 570-575
• 21 Endo M, Yoshino K, Kawano T. et al . Clinicopathologic analysis of lymph node metastasis in surgically resected superficial cancer of thoracic esophagus.  Dis Esophagus. 2000;  13 125-129
• 22 Makuuchi H. Endoscopic mucosal resection for mucosal cancer in the esophagus.  Gastrointest Endosc Clin N Am. 2001;  11 445-458
• 23 Pech O, Gossner L, May A. et al . Endoscopic resection of superficial esophageal squamous-cell carcinomas: Western experience.  Am J Gastroenterol. 2004;  99 1226-1232
• 24 Giovannini M, Bernardini D, Moutardier V. et al . Endoscopic mucosal resection (EMR): results and prognostic factors in 21 patients.  Endoscopy. 1999;  31 698-701
• 25 Mori M, Adachi Y, Matsushima T. et al . Lugol staining pattern and histology of esophageal lesions.  Am J Gastroenterol. 1993;  88 701-705
• 26 Inoue H, Rey J F, Lightdale C. Lugol chromoendoscopy for esophageal squamous cell cancer.  Endoscopy. 2001;  33 75-79
• 27 Shimizu Y, Tsukagoshi H, Fujita M. et al . Endoscopic screening for early esophageal cancer by iodine staining in patients with other current or prior primary cancers.  Gastrointest Endosc. 2001;  53 1-5
• 28 Radu A, Grosjean P, Fontolliet C. et al . Endoscopic mucosal resection in the esophagus with a new rigid device: an animal study.  Endoscopy. 2004;  36 298-305